在临床实际中，一个RCC中会出现不同种结构，是单一种RCC的不同结构？还是不同RCC的混合？
慢慢琢磨，仔细体会。Chromophobe Renal Cell Carcinoma: A Clinicopathologic Study of 203 Tumors in 200 Patients With Primary Resection at a Single Institution (Am J Surg Pathol 2011;35:962–970)
Abstract: Despite multiple studies, many clinicopathologic
issues about chromophobe renal cell carcinoma (RCC) remain
contentious; for example, its biological behavior-whether better
or similar to papillary RCC, the incidence of sarcomatoid
features, and whether pathologic features such as necrosis, nu-
clear grade, and tumor stage predict worse outcome. We studied
203 consecutive primary chromophobe RCCs resected at our
institution in an attempt to answer these and other questions.
The tumors showed significant progressive decrease in size and
stage (P=0.047 and 0.001) from 1980 to 2000. Five patients
had metastasis at presentation, and further disease-specific
events (recurrence/metastasis/death due to disease) occurred in
8 more. Only 4 of 203 tumors had sarcomatoid features. Over
median follow-up of 6.1 years (range, 0.1 to 18 y), 5-year and
10-year disease-specific events occurred in 3.7% (95% CI, 1.5%,
7.4%) and 6.4% (95% CI, 2.7%, 12.2%) patients. Outcomes
showed significant association with tumor size, small-vessel in-
vasion, sarcomatoid features, and microscopic necrosis (Pr0.05
each). pT stage or nodal metastasis tended to show some
association, without reaching statistical significance (P=0.05
and 0.06, respectively). A modified tumor grading scheme,
somewhat similar to that proposed recently, mitotic index, cyto-
logic eosinophilia, and architecture, were not significantly asso-
ciated with outcome. In conclusion, sarcomatoid differentiation is
quite uncommon in chromophobe RCC. Tumor size, small-vessel
invasion, sarcomatoid differentiation, and microscopic necrosis
are the only features that are significantly associated with adverse
outcome. On the basis of this long follow-up on a large number of
cases, chromophobes seem to have better clinical outcomes than
those reported for clear cell and papillary RCCs.